TY - JOUR
T1 - A differential of the left eye and right eye neurological pupil index is associated with discharge modified Rankin scores in neurologically injured patients
AU - the END PANIC Investigators
AU - Privitera, Claudio M.
AU - Neerukonda, Sanjay V.
AU - Aiyagari, Venkatesh
AU - Yokobori, Shoji
AU - Puccio, Ava M.
AU - Schneider, Nathan J.
AU - Stutzman, Sonja E.
AU - Olson, Dai Wai M.
AU - Hill, Michelle
AU - DeWitt, Jessica
AU - Atem, Folefac
AU - Barnes, Arianna
AU - Xie, Donglu
AU - Kuramatsu, Joji
AU - Koehn, Julia
AU - Swab, Stefan
N1 - Funding Information:
The study received partial funding in research grant support from NeurOptics, Inc. The design, data collection, and maintenance of the ENDPANIC registry is solely guided by the primary investigator and NeurOptics does not participate in the registry. One member of the writing group for this analysis (CP) is an employee at NeurOptics and did participate in interpretation of the results for this paper.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality. Methods: We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements. Results: Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P <.001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P <.001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P <.001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P <.001). Conclusion: The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units. Trial registration: NCT02804438, Date of Registration: June 17, 2016.
AB - Background: Automated infrared pupillometry (AIP) and the Neurological Pupil index (NPi) provide an objective means of assessing and trending the pupillary light reflex (PLR) across a broad spectrum of neurological diseases. NPi quantifies the PLR and ranges from 0 to 5; in healthy individuals, the NPi of both eyes is expected to be ≥ 3.0 and symmetric. AIP values demonstrate emerging value as a prognostic tool with predictive properties that could allow practitioners to anticipate neurological deterioration and recovery. The presence of an NPi differential (a difference ≥ 0.7 between the left and right eye) is a potential sign of neurological abnormality. Methods: We explored NPi differential by considering the modified Rankin Score at discharge (DC mRS) among patients admitted to neuroscience intensive care units (NSICU) of 4 U.S. and 1 Japanese hospitals and for two cohorts of brain injuries: stroke (including subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, and aneurysm, 1,200 total patients) and 185 traumatic brain injury (TBI) patients for a total of more than 54,000 pupillary measurements. Results: Stroke patients with at least 1 occurrence of an NPi differential during their NSICU stay have higher DC mRS scores (3.9) compared to those without an NPi differential (2.7; P <.001). Patients with TBI and at least 1 occurrence of an NPi differential during their NSICU stay have higher discharge modified Rankin Scale scores (4.1) compared to those without an NPi differential (2.9; P <.001). When patients experience both abnormalities, abnormal (NPi < 3.0) and an NPi differential, the latter has an anticipatory relationship with respect to the former (P <.001 for z-score skewness analysis). Finally, our analysis confirmed ≥ 0.7 as the optimal cutoff value for the NPi differential (AUC = 0.71, P <.001). Conclusion: The NPi differential is an important factor that clinicians should consider when managing critically ill neurological injured patients admitted to the neurocritical care units. Trial registration: NCT02804438, Date of Registration: June 17, 2016.
KW - Modified Rankin Score (mRS)
KW - NPi differential
KW - Neurocritical care
KW - Neurological Pupil index (NPi)
KW - Pupillary light reflex (PLR)
KW - Pupillometry
UR - http://www.scopus.com/inward/record.url?scp=85134600254&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85134600254&partnerID=8YFLogxK
U2 - 10.1186/s12883-022-02801-3
DO - 10.1186/s12883-022-02801-3
M3 - Article
C2 - 35869429
AN - SCOPUS:85134600254
SN - 1471-2377
VL - 22
JO - BMC Neurology
JF - BMC Neurology
IS - 1
M1 - 273
ER -